Vitamin E : Dosing

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Standardization:

Forms of vitamin E and conversion factors: Dosing and daily allowance recommendations for vitamin E are often provided in Alpha-Tocopherol Equivalents (ATE) to account for the different biological activities of the various forms of vitamin E, as well as in International Units (IU) which food and supplement labels often use. For conversion, 1mg ATE = 1.5 IU. To convert IUs of RRR-alpha-tocopherol (natural vitamin E) to milligrams of alpha-tocopherol, multiply by a factor of 0.67. To convert IUs of all-rac-tocopherol (synthetic vitamin E) to milligrams of alpha-tocopherol, multiply by a factor of 0.45.

The same conversion factors are used for either acetate or succinate salts (because the content has been adjusted for the molecular weights of the salts).

Dietary Sources of Vitamin E:

Eggs, fortified cereals, fruit, green leafy vegetables (such as spinach), meat, nuts/nut oils, poultry, vegetable oils (corn, cottonseed, safflower, soybean, sunflower), wheat germ oil, whole grains. Cooking and storage may destroy some of the vitamin E in foods.

Adults (18 years and older):

U.S. Recommended Daily Allowance (RDA) for adults: Most individuals in the U.S. are believed to obtain sufficient vitamin E from dietary sources, although individuals with very low-fat diets or intestinal malabsorption disorders may require supplementation. RDAs for vitamin E are provided in Alpha-Tocopherol Equivalents (ATE) to account for the different biological activities of the various forms of vitamin E, as well as in International Units (IU) which food and supplement labels often use. For conversion, 1mg ATE = 1.5 IU. The RDA for men or women older than 14-years-old is 15mg (or 22.5 IU); for pregnant women of any age is 15mg (or 22.5 IU); and for breastfeeding women of any age is 19mg (or 28.5 IU). (See: Institute of Medicine, Food and Nutrition board. Dietary Reference Intakes: Vitamin C, Vitamin E, Selenium, and Carotenoids. National Academy Press, Washington, DC, 2000; National Research Council, Food and Nutrition Board. Recommended Dietary Allowances, 10th ed. Washington, DC: National Academy Press, 1989.)

Tolerable Upper Intake Levels (UL) for adults:For adults older than 18 years, the tolerable upper limit of dosing for supplementary alpha-tocopherol recommended by the U.S. Institute of Medicine is 1000mg/day (equivalent to 1500 IU). This limit recommendation is not altered during pregnancy or breastfeeding.

Vitamin E deficiency: Treatment should be under medical supervision, tailored to the underlying cause of the deficiency, and may include either oral or injected vitamin E. If the cause is due to chronic malnutrition and there is no evidence of malabsorption, an oral dose which is between 2-5 times greater than the RDA may be considered. If the cause is malabsorption which cannot be corrected, then injections of vitamin E may be necessary. Dosing recommendations vary by the underlying cause. For example, for abetalipoproteinemia, 100-200 IU/kg/day has been recommended; for chronic cholestasis, 15-25 IU/kg/day has been used; in cystic fibrosis, 5-10 IU/kg/day has been used; and in short-bowel syndrome, 200-3600 IU/day has been used. For isolated vitamin E deficiency, between 800-3600 IU/day has been used.

Other conditions: No specific dosing of vitamin E has been established for other conditions, and there is recent evidence suggesting possible adverse health effects of long-term use of daily supplementation with 400 IU or greater daily. Although controversial, the use of long-term vitamin E supplementation should be approached cautiously until further evidence from prospective clinical trials is available. Various doses and durations have been evaluated in clinical trials, although many have not been proven as effective or safe. Patents are recommended to discuss the choice of dosing and duration with a licensed healthcare professional. Examples of doses use in studies include: ForAlzheimer's disease, up to 2000 IU daily has been used or combination therapy of donepezil (Aricept) 5mg with vitamin E 1000 IU daily. Forbeta-thalassemia, vitamin E 750 IU daily has been used. For treatingchemotherapy extravasation, a 10% vitamin E solution has been used topically in combination with 90% dimethyl sulfoxide (DMSO). For prevention ofcisplatin neurotoxicity, vitamin E (alpha-tocopherol) 300mg daily has been used with each chemotherapy treatment and continued for up to 3 months after stopping cisplatin therapy. Fordiabetic neuropathy, vitamin E (type unspecified) 900mg daily has been used. Fordysmenorrhea, vitamin E 500 IU daily has been used starting 2 days before the menstrual period commences, and continuing through the first 3 days of bleeding. ForG6PD deficiency, vitamin E (type unspecified) 800 IU daily has been used. For earlyHuntington's chorea, RRR-alpha-tocopherol (natural vitamin E) 3000 IU has been used. For improvingmale fertility, vitamin E (type unspecified) 200 to 600 IU daily has been studied. In myotonic dystrophy, 800mg/day has been used. For the prevention ofnitrate tolerance, vitamin E (type unspecified) 200mg three times daily has been used. Fornocturnal leg cramps, vitamin E (type unspecified) 400 IU at bedtime has been used. For preventingpre-eclampsiain high risk women, vitamin E 400 IU with vitamin C 1000mg daily has been used. Forprostate cancer prevention, the effects of 50mg alpha-tocopherol, or vitamin E (type unspecified) 50-100 IU daily have been evaluated. Followingphotoreactive keratectomy, to accelerate re-epithelialization, 230mg of vitamin E (alpha-tocopheryl nicotinate) and vitamin A (retinol palmitate) 25,000 units have been used 3 times daily for 30 days, followed by twice daily for 2 months. Forpremenstrual syndrome (PMS), RRR-alpha-tocopherol (natural vitamin E) 400 IU daily has been used. Forradiation-induced fibrosis, vitamin E (type unspecified) 1000 IU daily in combination with pentoxifylline 800 mg has been used. Forrestless leg syndrome, 400 IU twice daily has been used. Forrheumatoid arthritis pain, vitamin E (type unspecified) 600 IU twice daily has been evaluated. For sickle cell anemia, 450 IU daily has been used. In seizure disorder, 400 IU/day has been used. Forsunburn prevention, RRR-alpha-tocopherol 1000 IU in combination with 2 grams of ascorbic acid has been studied.

Children (younger than 18 years):

U.S. Recommended Daily Allowance (RDA) and Adequate Intake (AI) for infants/children: RDAs for vitamin E are provided in Alpha-Tocopherol Equivalents (ATE) to account for the different biological activities of the various forms of vitamin E, as well as in International Units (IU), because food and supplement labels often use this system. For conversion, 1mg ATE = 1.5 IU. There is no RDA for infants, and rather there is a recommended Adequate Intake (AI) for healthy breastfeeding infants ages 0-6 months-old of 4mg/day (6 IU/day), and for infants ages 7-12 months-old of 5mg/day (7.5 IU/day). The RDA for children ages 1-3 years-old is 6mg/day (9 IU/day); for ages 4-8 years-old is 7mg/day (10.5 IU/day); for ages 9-13 years-old is 11mg/day (16.5 IU/day); for ages greater than 14 years-old is 15mg/day (22.5 IU/day); for pregnant women of any age is 15mg (or 22.5 IU); and for breastfeeding women of any age is 19mg (or 28.5 IU). (See: Institute of Medicine, Food and Nutrition board. Dietary Reference Intakes: Vitamin C, Vitamin E, Selenium, and Carotenoids. National Academy Press, Washington, DC, 2000; National Research Council, Food and Nutrition Board. Recommended Dietary Allowances, 10th ed. Washington, DC: National Academy Press, 1989.)

Tolerable Upper Intake Levels (UL) for infants/children:An upper limit for infants up to 12 months of age has not been established. The tolerable daily upper limit of dosing for ages 1-3 years-old is 200mg (300 IU); for ages 4-8 years-old is 300mg (450 IU); for ages 9-13 years-old is 600mg (900 IU); and for ages 14-18 is 800mg (1200 IU).Vitamin E deficiency: Treatment should be under medical supervision, tailored to the underlying cause of the deficiency, and may include either oral or injected vitamin E. Selected doses in specific conditions are noted above under adult dosing.

Other conditions: No specific dosing of vitamin E has been established for other conditions. In premature neonates, oral vitamin E 15-30 IU/kg/day has been studied to prevent retinopathy and bronchopulmonary dysplasia. For anemia of prematurity, 50 IU daily has been studied for up to 6 weeks. For children with focal segmental glomerulosclerosis, vitamin E 200 IU has been studied to reduce proteinuria.

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